Public Bill Committee

[Mr Phillip Hollobonein the Chair]

Clause 3

Amendment proposed (this day): 48, page2,leave out lines 26 and 27 and insert—

Question again proposed, That the amendment be made.

Philip Hollobone: I am a substitute Chair. I remind the Committee that with this we are discussing the following: amendment 50, in clause3,page2,leave out lines 26 and 27 and insert—
Amendment 52, in clause3,page2,leave out lines 26 and 27 and insert—
Amendment 46, in clause3,page2,line27,leave out from ‘reached’ to end of line and insert ‘the 12th week of her pregnancy before 1 January 2014.’.
Amendment 44, in clause3,page2,line27,leave out ‘2011’ and insert ‘2014’.
Amendment 49, in clause3,page2,leave out lines 31 and 32 and insert—
Amendment 51, in clause3,page2,leave out lines 31 and 32 and insert—
Amendment 53, in clause3,page2,leave out lines 31 and 32 and insert—
Amendment 47, in clause3,page2,line32,leave out from ‘reached’ to end of line and insert ‘the 12th week of her pregnancy before 1 January 2014.’.
Amendment 45, in clause3,page2,line32,leave out ‘2011’ and insert ‘2014’.
Clause stand part.

Kerry McCarthy: It is an immense pleasure to see you, Mr Hollobone, in the Chair to oversee the rest of the Committee’s proceedings.
In the interest of brevity, I will just say that I would like to press amendments 50, 52 and 44 to a vote.
I beg to ask leave to withdraw the amendment.

Amendment, by leave, withdrawn.

Amendment proposed: 50, in clause3,page2,leave out lines 26 and 27 and insert—

The Committee divided: Ayes 7, Noes 10.

Question accordingly negatived.

Amendment proposed: 52, in clause3,page2,leave out lines 26 and 27 and insert—

Question put, That the amendment be made.

The Committee divided: Ayes 7, Noes 10.

Question accordingly negatived.

Amendment proposed: 44, in clause3,page2,line27,leave out ‘2011’ and insert ‘2014’.—(Kerry McCarthy.)

Question put, That the amendment be made.

The Committee divided: Ayes 7, Noes 10.

Question accordingly negatived.

Kate Green: I beg to move amendment 42, in clause3,page2,line32,at end add—
I am sure that I speak for the Committee in saying how pleased we are to see you in the Chair, Mr Hollobone.
The amendment requests that the Government produce an assessment of the impact of the health in pregnancy grant on mental health and educational outcomes, and of its cost to the taxpayer, before its withdrawal under the Bill. I drafted it in response to the keen interest in maternal physical and psychological health and well-being shown by members of the Committee of all parties in the evidence sessions. That anticipated the interest that was shown in this morning’s sitting in a good evidence base for the decision on whether to withdraw the grant. The amendment would allow time for that evidence base properly to be prepared.
There is agreement across the Committee on the importance of maternal health and well-being to the birth of a healthy baby. Poor maternal health is often the result of poor diet. Other adverse conditions during pregnancy, such as poor housing, and other concerns about maternal well-being lead to low birth weight, which, in turn, produces a range of poor outcomes for babies in educational results, health and social well-being down the line.
We are debating a philosophical understanding of the importance of family income contributions to maternal well-being and, ultimately, the birth of healthy babies. One of the important aspects of the health in pregnancy grant is that, for obvious reasons, it is focused clearly on mothers. It is paid to women. It has also been suggested that we see it as a possible advance on child benefit, which is taken up substantially by women. The analogy with advance child benefit is not quite right. Our system does not recognise benefits for the unborn child, but it is clear about paying benefits to meet particular needs or circumstances. The health in pregnancy grant is very much focused on maternal well-being and maternal health in the broadest sense.
It is important that the grant is paid to women. We have seen that many other measures introduced by the coalition Government in the emergency Budget and comprehensive spending review are already hitting women very hard. In fact, they have been hit twice as hard as men as a result of the spending decisions so far. In her evidence to us last week, Louise Silverton from the Royal College of Midwives highlighted the importance of the grant and its payment to women. She said that, particularly in certain communities and within certain cultures, she could not understate the importance of grants that were paid to women to give them financial autonomy in the context of those households.
This morning, we debated whether it was appropriate to pay a lump sum grant or whether regular payments—weekly or monthly—might be more important. Much of the evidence that we heard last week from witnesses was that the lump sum was quite useful in meeting some lumpy costs as mothers prepare for the arrival of a new baby, such as the purchase of cots, clothing and so on. However, the point about the grant being in a lump sum means that it frees up pressure on household budgets and thus enables women to afford the day-to-day costs of eating a healthy diet and meeting other health-related needs, for example, keeping the home warm and dry.
It is important to recognise that although the Sure Start maternity grant obviously helps in addition with some lumpy items of expenditure, it will now be withdrawn from all but the first child, and that mothers will continue to face particular financial pressures as they prepare for the arrival of a new baby—expenses with which the grant can clearly help.
I said that, in essence, the debate was about the importance of adequate incomes in the context of maternal well-being and healthy babies. An unemployed woman in receipt of jobseeker’s allowance will currently receive a benefit of £65.45 a week. If she is under 25, the sum is £51.85. That leaves a shortfall against the relative poverty line, set at 60% of median income after housing costs, of between £50 and £65—a substantial amount of money, whereby young women on jobseeker’s allowance who are expecting children find themselves short of the poverty line.
The research carried out for the Joseph Rowntree Foundation into the minimum income standard showed that the position is even worse, and that the minimum income standard sets a minimum weekly budget for food expenditure of £44. That is a standard set both by objective evidence from nutritionists identifying what a healthy diet would cost and look like, and objective external evidence from consultation with a range of individuals—a focus group or panel—representing society as a whole and who found £44 to be the necessary sum needed weekly to afford a healthy diet.

Kate Green: The health in pregnancy grant addresses several objectives. It boosts family income and seeks to support women to live healthily in the final weeks of pregnancy. It ensures that they are in touch with health care professionals as they go through pregnancy, and, as I will discuss later, it tries to influence and change behaviour in the long term, something that my hon. Friends and I feel to be very important indeed.
I want to return for a moment to the incomes on which women on jobseeker’s allowance and low incomes may be trying to afford a healthy diet. There can be a substantial shortfall between jobseeker’s allowance and the poverty line, leaving them substantially short of money to afford the minimum food standard and other necessities. That position will be worsened if jobseeker’s allowance is uprated by the consumer prices index over time. That forces mothers to rob Peter to pay Paul. If they are to afford a healthy diet, they have to sacrifice spending on other necessities, and the health in pregnancy grant seeks to help address that.

Claire Perry: Unlike my hon. Friend the Member for Blackpool North and Cleveleys, I look forward to hearing the hon. Lady when she is on the Front Bench.
May I address the rather important elephant in the room? Given that the families are in extreme poverty, as the hon. Lady points out, should they be having children at that point? Is £190 enough to ensure that that decision is a sensible one?

Kate Green: I am reluctant to stray into taking decisions about when women ought to have children. That is very much a personal and private decision for every woman. I remind the hon. Lady of Louise Silverton’s evidence that a substantial number of pregnancies are unplanned, and that applies right across the income spectrum. As she pointed out in her evidence, that does not mean that they are unwanted pregnancies and unwanted children, but it does mean that it is imperative to ensure that all women of child-bearing age are protected so that they can maintain a healthy diet, because so much conception is unplanned. Valid arguments were made by Government members of the Committee earlier in our proceedings about wanting to build good maternal health as early as possible, well before the 25th week. I do not think that we can lose a moment in doing everything we can, including using the health in pregnancy grant, to boost the incomes of women of child-bearing age.

Kerry McCarthy: Will my hon. Friend confirm the evidence that was given last week that becoming pregnant can push somebody into poverty in some cases? In this morning’s sitting, I referred to the fact that women can lose their jobs as a result of becoming pregnant, and they may not even realise that they can lose their job. That is what pushes them into poverty. Therefore, the point made by the hon. Member for Devizes about women choosing to become pregnant when they are on low incomes does not necessarily stack up.

Kate Green: We heard evidence in earlier sessions that pregnancy is a risk factor for tipping women into poverty, including for the reason outlined by my hon. Friend. It reinforces the importance of having protective mechanisms to sustain family income during pregnancy, and the health in pregnancy grant contributes to that.
My hon. Friend the Member for Makerfield pointed out that the health in pregnancy grant removes an element of financial strain, stress and anxiety in the latter weeks of pregnancy, making at least an indirect contribution to women’s good mental health. We should therefore see its contribution to health in the broadest possible sense of what we mean by maternal health. Poor diet is one factor that the grant seeks to address, as well as meeting other family bills. Its contribution to a woman’s being able to prepare for childbirth in a calm and confident frame of mind should not be underestimated.
I welcome you to the Chair, Mr Howarth. There has rightly been considerable discussion of whether the benefit is paid at the right time, and about whether the 25th week is too late for it to be of use. That valid concern was raised by the hon. Member for Devizes this morning. Many of our witnesses suggested that we need both a lump-sum payment towards the end of pregnancy and regular payments during pregnancy. We heard this morning how difficult it can be to pitch the payment during pregnancy at the right moment. The hon. Member for West Worcestershire spoke eloquently about the distress that might be caused if a benefit was paid early in pregnancy and then withdrawn because of the woman losing the baby before full term.
It is because of those uncertainties and complexities that my amendment suggests a period for reflection and consideration of the evidence. It would provide an opportunity to consider whether there are design issues in what is still a new grant—a relatively new baby, one might say—in the range of financial support for pregnant women. Rather than scrapping it, we should consider whether it can be improved or enhanced.
Belinda Phipps was clear in her evidence that the income of women in pregnancy, in particular that of poor women, was “simply insufficient”. In the light of that evidence, it is vital that we do not make measures in this House that will worsen the financial position of those poor women.

Sarah Newton: The social determinants of health are well understood, thanks to the pioneering work of Sir Michael Marmot. Does the hon. Lady agree that the recent health White Paper reconfirms the Government’s commitment to reducing health inequalities? We should take great comfort from the fact that one of the Ministers was a district nurse for some 20 years before entering Parliament. Does the hon. Lady also agree that the proposals in the White Paper for local directors of public health, who will have the ability to work with people in housing and social services, as well as having all the NHS resources, will provide the holistic care that women need for their health and that of their babies?

Philip Hollobone: Order. Before the hon. Member for Stretford and Urmston responds, it is important to emphasise that interventions should be brief and to the point. They should cover a single point that is relevant to the amendment under consideration.

Kate Green: All the features mentioned by the hon. Member for Truro and Falmouth are welcome. I welcome the recognition of their importance in the White Paper published by the Secretary of State for Health.
Sir Michael Marmot’s report makes it clear that one of the most important factors in reducing health inequalities is ensuring that we secure adequate incomes for families. It states that the single most important measure that can be taken to reduce health inequalities is to continue to increase the national minimum wage. That clearly makes the point that whatever other steps are taken by public health directors, health professionals, social services and those who work with women as they move towards motherhood, we cannot overstate the importance of family income. That is the point that can be drawn from Sir Michael Marmot’s report, to which the hon. Lady rightly referred.
This morning, we discussed whether the payments should be universal or targeted. Labour Members are passionate about retaining the universal benefit. We accept that we face difficult financial circumstances and that it may be helpful to have an examination of whether the payment would still do some good, albeit more limited, if it were targeted or means-tested. None the less, I point to the evidence of Dr Katherine Rake, to which my hon. Friend the Member for Bristol East alluded, that women often become poor during pregnancy, as a result of pregnancy and after childbirth. A universal payment does not try to anticipate whether a woman might become poor, but it locks the stable door before the horse is stolen and puts a protective and preventive mechanism in the way.
It is also the case that means-testing is much more complex and costly, so a Government who seek to keep costs under careful management would naturally be attracted to universal benefits. 
This morning, the hon. Member for Truro and Falmouth mentioned the importance of links with health professionals, and I think that she has just alluded to that. It also came up in evidence from Louise Silverton last week. Most women are desperate to do their best for their new baby—they are anxious and eager to receive professional support. Louise Silverton was clear, however, that there is an appropriate level of such support and that we do not need to be over-bureaucratic or heavy-handed in providing it. She suggested that health checks were probably not needed much before the 12th week.

Philip Hollobone: Order. I remind the hon. Lady that she is speaking about the amendment, the two parts of which relate to a delay in the implementation of clause 3 and the production of a report. She is now making a clause stand part speech and that debate has already taken place. Perhaps, therefore, she will relate her remarks to her amendment.

Kate Green: Of course I will, Mr Howarth. My amendment proposes a period during which we could reflect, gather evidence and produce a fully worked-through analysis. The point that underlies my remarks is that all the issues that have been raised in Committee by other hon. Members and by me could be properly addressed if the amendment were accepted.
I allude to the behavioural consequences of the grant, which Dr Katherine Rake raised. She suggested that we could not evaluate the programme as simply a short-term measure with immediate impacts on the diet and maternal health of pregnant women, but that we should also consider its longer-term behavioural consequences as family eating habits change. We will need to take time to design the evaluation that could reveal and unpick the evidence. It is fair to say that that was not properly worked through when the grant was introduced. Clearly, however, as a result of the helpful debate that has taken place in Committee, we see that such an evaluation is now needed.

Harriett Baldwin: From the hon. Lady’s knowledge base, is there a particular area on which she feels that the report could focus between now and June 2011?

Kate Green: It would be extremely helpful to test a number of things in the report. First, we could simply lay out the evidence on the connection between income, maternal well-being and long-term outcomes for children. Given that the grant has only been in place since last year, 30 June 2011 will be too early to tease that through for the children of mothers who have received it. It would be helpful research, however, to identify the parameters of that impact.
Secondly, it would be useful to obtain more evidence about how women responded to receiving the grant. Such evidence would relate not only to what they spent it on, but to how it affected their emotional attitudes to the arrival of the new baby—their sense of security and confidence and, therefore, the impact on their mental health.
Thirdly, it would be important for us to talk to women in any such survey about how the scheme has opened up their thinking about diet and eating habits and how, as new mothers, they have taken that into family life.
Fourthly, as proposed in my amendment, it would be well worth seeing a worked-through model of the savings to the taxpayer that are made by improving child outcomes by reducing the number of babies who are born with low birth weight.
In conclusion, I think it was the hon. Member for Birmingham, Yardley, who is not in Committee, who asked us repeatedly what the evidence was that supported the introduction of the health in pregnancy grant. There was considerable evidence of the importance of good maternal health in improving the birth weight of new babies and their long-term outcomes. It has become clear, as we have heard evidence from witnesses and as we have been in Committee over the past two weeks, that there is much more evidence. It would be useful to understand that as a cost-benefit to the taxpayer, a concern which the Minister rightly has. My amendment seeks only a short delay, until next June, to gather and properly analyse that evidence. I very much hope that it will be accepted by all members of the Committee.

Mark Hoban: It is a pleasure to follow the hon. Lady, who speaks with knowledge and experience of those issues, but she did not address one matter. She talked about the overall cost to the taxpayer, but she did not refer to how we would find the £70 million that the delay would cost. What cuts would we have to make to fund that delay? Does she want us to reduce the Sure Start maternity grant or the Healthy Start scheme? Does she want us to increase taxes or borrowing? She made no mention whatever of how the delay would be paid for.
Repeated themes in the debate have been the arguments for delays and for putting things off, and for open-ended spending commitments, including to increase the health in pregnancy grant, but there has been no reference to how such costs would be financed.

David Hanson: Will the Financial Secretary give way?

Mark Hoban: It is a bit late for the right hon. Gentleman to come in, but I will let him explain.

David Hanson: The Financial Secretary knows that there is a clear difference between the Government and the Opposition on deficit-reduction plans. We have presented an alternative, which extends the reduction over a longer period and does not cut as deep, but which still halves the deficit within four years. He has made a political choice to have a smaller state, and to put women and children first under that political choice. [ Interruption. ]

Mark Hoban: As is asked from a sedentary position, “What’s the plan?” It is all very well to say that there is a plan—we have not seen any plan, only heard about it. There is a huge issue here about affordability, which is what the Government are trying to tackle through the Bill.
Our most urgent task is to reduce the financial deficit fairly. The health in pregnancy grant is not effectively targeted on those who need support in pregnancy. As we know, it does not require the recipients to spend the money on better health or well-being. Abolishing it will save £40 million in 2010-11 and £150 million a year from 2011-12 onwards. The hon. Member for Stretford and Urmston presents her amendment as a small delay—only a few months—but it would cost taxpayers £70 million, which is not money that we can afford. As she acknowledged in her remarks, everyone on the Committee recognises the importance of good nutrition to maternal health and outcomes, and there is no doubt about that.
I repeat what Belinda Phipps of the National Childbirth Trust said in her evidence:
“If you are setting out primarily to improve the nutrition of the mother to improve the health of the baby,”
the payment of the health in pregnancy grant
“needs to be earlier. If you…really want to change the future of the baby, it needs to be as early as possible. It is not possible easily to do it pre-conception, but the earlier in pregnancy you can do it, the better.”––[Official Report, Savings Accounts and Health in Pregnancy Grant Public Bill Committee, 4 November 2010; c. 79, Q205.]
Therefore, we know that, without having to go through expensive and time-consuming research, the grant is not well targeted if we are trying to improve the health of mothers. That is why other measures have been put in place.
I take on board the point made by the hon. Member for Stretford and Urmston about the need for long-term behavioural changes, and the Healthy Start vouchers, which start in the early months of pregnancy and continue until the child is four, are a good way of giving such support. Again, the Sure Start maternity grant gives targeted support in the early stages of pregnancy to enable people on low incomes to deal with lumpy one-off costs, which is very important. In a way, the grant has been set up to fail, in that it will not pass the tests that she has set, because of the way it has been designed. In earlier discussions, she talked about ways in which support should be given to pregnant mothers, but the grant does not really fit the bill.
The hon. Member for Bristol East made a point about the grant being an early payment of child benefit. I want to pick up the hon. Member for Stretford and Urmston for criticising that. The 2006 pre-Budget report states:
“From April 2009, every mother-to-be will become eligible for Child Benefit from week 29 of their pregnancy”.
Of course, that is the precursor to the scheme. Without consultation, the Government changed the design of the scheme. The 2006 pre-Budget report continues,
“women will be up to £200 better off by the birth of their first child and up to £130 better off at the birth of subsequent children.”
Clearly, this grant was announced in a way that was about the early payment of child benefit. The hon. Member for Bristol East was right on that basis.

Kate Green: I want to pick up on a point that we mentioned this morning, when the Minister discussed what consultation had taken place. It is correct that, at the time of the PBR, the grant was presented as advance child benefit. It was in response to representations from a range of bodies—as I said to the Minister this morning, there was a very lively discussion about its not being appropriate to tie a benefit to an unborn child—that it became the health in pregnancy grant when it was launched in 2008-09.

Mark Hoban: I was trying to clarify why the hon. Member for Bristol East made that point and phrased it in that way, because it reflects how the initial announcement was made. I am in danger of repeating the points that I made earlier and I do not wish to trespass on the Committee’s patience. The report will not help. We know how the scheme is designed and it will not achieve the objectives that hon. Members ascribe to it. It is best that we make progress on tackling the deficit, and I urge the hon. Member for Stretford and Urmston to withdraw the amendment.

Kate Green: I will be brief, because we have had a good debate in Committee, particularly this morning when the issues were well rehearsed by hon. Members of all parties. I will pick up on a couple of points that the Minister raised in his remarks. He asked how we would pay for the benefit and where the cuts would be made. Dr Katherine Rake pointed out that all the cuts were being made to family budgets and that the health in pregnancy grant was not being cut to pay for another benefit for families. Families are being hit across the board. That is why it is important that our deficit reduction plan is more measured, slower and recognises that we do not need to go for full deficit elimination as fast as the Government intend, because our families and our children are paying the price.
I am clear that the amendment gives us time to answer properly the many incredibly valid and important points that came up in the discussion in Committee this morning. It is casual and irresponsible of the Government, when presented with this reasonable amendment, not to take the opportunity to carry out that analysis. If the Minister is confident that, when the analysis is eventually presented, the amendment will be shown as doomed to fail—I do not agree with that, but taking what he has said at face value—he has nothing to fear from it. He should have nothing to fear from carrying out the proper analysis that he criticised us for not conducting before the grant was introduced. I strongly urge hon. Members to support the amendment, not least because of the strong signal that it will send about the importance that we all attach to good maternal nutrition, good maternal health and the need for income support for expectant mothers to ensure that we can secure that.

Question put,That the amendment be made.

The Committee divided: Ayes 7, Noes 10.

Question accordingly negatived.

Question put, That the clause stand part of the Bill.

The Committee divided: Ayes 10, Noes 7.

Question accordingly agreed to.

Clause 3 ordered to stand part of the Bill.

Clause 4

Question put, That the clause stand part of the Bill.

The Committee divided: Ayes 10, Noes 7.

Question accordingly agreed to.

Clause 4 ordered to stand part of the Bill.

Ordered,
That certain written evidence already reported to the House be appended to the proceedings of the Committee.—(Mr Hoban.)

Mark Hoban: On a point of order, Mr Howarth. I would like to take the opportunity to thank you and your co-Chair, Mr Streeter, for the way in which you have chaired the proceedings over the course of not just the scrutiny sessions, but the evidence sessions. You have ensured between you that we made good progress on the Bill. I thank my hon. Friend the Member for Scarborough and Whitby and the hon. Member for West Ham, who have developed a good working relationship as the usual channels on the Bill. I also thank the Committee Clerks, the Hansard reporters, who had to make sense of our speeches over the past few days, the Doorkeepers and the police.
I thank my hon. Friends for their contributions and advise them that, given that before the election, Government Back Benchers were not allowed to speak, they should realise how lucky they are to have that freedom in the debates. I also thank the right hon. Member for Delyn and the hon. Member for Bristol East for leading the Opposition in their scrutiny of the Bill. I think we had a good debate. We have kicked the tyres on the Bill at some length, and are none the worse for doing so. I would also like to thank the Bill team for doing an excellent job in putting it together and ensuring that I had good material to use during the proceedings.

David Hanson: Further to that point of order, Mr Howarth. May I also thank you and your co-Chair, Mr Streeter, and, indeed, Mr Hollobone, for assisting with chairing the Committee? It is particularly appropriate that we meet today in Committee Room 10, where at the far end of the room is a picture of the unknown soldier being buried in Westminster abbey. During the debate, it struck me on this particular day what an important part of democracy it is to be in opposition, and in government, and how people have fought for that.
We have fulfilled our constitutional role, as the Prime Minister would say, in relating the challenges of the Bill. I would like to thank the Clerks, Mrs Davies and Dr Thatcher, and I thank Hansard. Hansard is remarkable; some days, we have long discussions into the night, and the reporters have done a very good job in putting our thoughts on paper. I thank my colleagues in the police, the Doorkeepers and all the officials who have helped with the Bill, including those from the Treasury, who have had to prepare notes on the amendments.
You will notice, Mr Howarth, that sadly the Bill leaves the Committee in exactly the same state as it entered, but I believe that some good arguments have been made. I thank my hon. Friend the Member for West Ham and the hon. Member for Scarborough and Whitby for their discussions. The fact that we have finished before our allotted time is due to negotiation, not because we would not still feel passionately in the last hour and three quarters about the issues in the Bill. I thank my hon. Friends for their contributions, and other Back Benchers, who have all spoken, with the exception of the two people whom I would not expect to speak—the Whip and the Parliamentary Private Secretary.
In passing, I have noticed that during votes on the Bill, we were always ahead until we reached the letter M when sadly, the latter half of the alphabet came in to help the Government maintain their majority. If I learn one thing from that, it is that hopefully in future Labour Members will have better chances of winning.
I thank everybody involved in the Bill, and I wish you well, Mr Howarth. We will see the Minister a week on Monday when we revisit the arguments. Just because we have lost the vote does not mean that we have lost the argument.

Bill to be reported, without amendment.

Committee rose.